Healthcare Provider Details

I. General information

NPI: 1316929722
Provider Name (Legal Business Name): JOHN P. DEWITT PSY.D. HSPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2005
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 COVERT AVE SUITE 201
EVANSVILLE IN
47714-5663
US

IV. Provider business mailing address

5233 TARRYTOWN RD
NEWBURGH IN
47630-2041
US

V. Phone/Fax

Practice location:
  • Phone: 812-428-6299
  • Fax:
Mailing address:
  • Phone: 812-428-6299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20040964A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: